Five-Year Competing Risk Analysis of Infectious and Non-Infectious Complications After Lung Transplantation: Real-World Evidence from a Multicenter EHR-Based Cohort

This study evaluates the 5-year incidence of major post-transplant outcomes using a competing risks framework.We analyzed data from 10,648 LTx recipients using the TriNetX U.S. Collaborative Network (January 1, 2015, to December 31, 2024).The Aalen-Johansen method was used to estimate the cumulative incidence function (CIF) of post-transplant complications.Infectious complications had the highest 5-year CIF (30.88%) and steepest annual trend (5.79%), slightly exceeding non-infectious complications (30.28%, 5.69%).Mortality reached 10.62%, and malignancies 6.72%.CMV showed the highest infectious burden (CIF 17.02%, annual trend 3.40%), with a steep rise within the first 180 days.Bacterial pneumonia followed a slower but sustained trajectory (CIF 9.1%, 1.8% annually).Statistical analyses confirmed significant differences across all outcomes (p < 0.001).Infectious and non-infectious J o u r n a l P r e -p r o o f complications dominate the post-LTx landscape and follow distinct temporal trajectories.Our data underscores the need for dynamic, risk-based surveillance and individualized prevention strategies to optimize long-term transplant outcomes.